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arbon p. (2004) Journal of Clinical Nursing 13, 150–157 Understanding experience in nursing This paper reviews research that considered the life stories of experienced nurses and the relationships between life experience, the way in which people find meaning in their experience(s), the development of nursing knowledge, and the influence of these events and understandings on the characteristics and clinical practice of experienced nurses. The dominant perspectives in nursing about the place of experience in the development of nurses’ practice are considered and the paper argues for a broader understanding of experience; placing experience within the context of nurses’ lives, connection with others and their individual understandings about nursing care. The place of experience in the development of nurses has not been well understood although the nursing discourse continues to value clinical experience highly. Becoming experienced as a nurse is described as a progressive and continuous interaction between experience, meaning and the lived world resulting in a personal and unique understanding of practice. The culture and discourse of nursing have tended to exclude or dampen individual difference and the paper considers a more expansive understanding of the place of experience and individual difference in nursing and the relevance of this perspective for the education of nurses. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper aims to provide a critical engagement with the subject of transcultural spirituality and nursing practice in the context of dying and bereavement. BACKGROUND: There has been considerable interest in the subject of spirituality over the past decade, and a particular association between the study of death and the study of spirituality. The nursing literature has been at the forefront of these developments amongst health and social care professionals. Some of this literature has begun to address the issues raised for culturally competent practice and the significance of patients' belief systems in the diverse cultural contexts with which nurses must engage in contemporary health care. However, the author argues that understanding of the range of contemporary spiritualities and transcultural practice is at an early stage. METHODS: Transcultural spirituality is explored through a critical review of the literature, including the author's own published research on spiritual and philosophical issues in death, dying and bereavement. CONCLUSION: The conclusion is drawn that some common themes and approaches can be found which offer a framework to guide nursing practice with the individual patient and family. RELEVANCE TO CLINICAL PRACTICE: In the absence of guidance, nurses struggle with implementing spiritual care in the fluid and complex context of contemporary spiritualities and frequently resort to broad categorizations. This paper opens up a way of connecting with the unique spiritual position of each patient. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. BACKGROUND: The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. CONCLUSION: The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. RELEVANCE TO CLINICAL PRACTICE: In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The aim of this study is to explore the introduction of portfolios into the first year of an MSc in Nursing Programme. BACKGROUND: This paper outlines a framework for portfolio development in postgraduate nursing practice. The framework is being piloted, within the Irish context, with students in the first year of a Masters in Nursing programme and has the potential to be developed for other nursing programmes at postgraduate level. DESIGN AND METHOD: An action research approach has been chosen to study the implementation of the portfolio and the development of a framework to guide this initiative. To date the development of the framework is being piloted as part of the 'taking action' phase of a first action research cycle. RESULTS: In its current stage of development the framework is constructed to embrace the core concepts of specialist nursing practice and the nursing management competencies, from current Irish health care documents. In addition the portfolio is anchored around personal development planning and is supported by the use of action learning tutorials and academic and practice facilitators. The first evaluating phase will take place later this year and will involve the collection of data from students, facilitators and lecturers. CONCLUSION: The introduction of the portfolio at postgraduate level has highlighted, to date, issues of confidentiality in committing experiences to paper, issues around its assessment, and issues around sharing this document with other students. RELEVANCE TO CLINICAL PRACTICE: Portfolio development at postgraduate level emphasizes linking theory and practice and stresses the importance of reflection on practice. The portfolio can also be used by nurses to develop their clinical career pathways and encourage personal development planning. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper considers the correct method for inserting a rectal suppository, both as a medication and also to achieve bowel evacuation. The aim is to find out whether the correct method is blunt end or pointed end foremost. Background. It follows from a question raised by a third year student nurse. In the classroom, she had been taught that the correct method for the administration of a suppository for systemic absorption was to insert it blunt end foremost into the rectum. However, if the suppository was to be used for evacuant purposes, it should be given pointed end foremost. In clinical practice, however, she was told the suppository should always be inserted pointed end foremost in all cases, whatever the purpose. Design. This article seeks to clarify the dilemma by examining the sources of evidence underpinning different methods for inserting a rectal suppository. Hence, the literature on the insertion of rectal suppositories was gathered as systematically as possible from medical journals and textbooks, nursing journals and textbooks and manufacturers' information to patients. Method. Having gathered the literature, this was examined, appraised and critically analysed for rigour, coherence and reliability. Results. The review of the literature appears to show that evidence adduced for inserting the suppository blunt end foremost derives from one study published in the Lancet in 1991, which challenged 'commonsense'. There did not appear to be other, more recent research. On the other hand, manufacturers' information to patients states generally that the suppository should be inserted pointed end foremost. This has direct relevance for the administration of suppositories and also raises questions as to how research may become integrated into healthcare practice without adequate justification. Conclusions. An article published in the Lancet in 1991 has had a fundamental effect on nursing practice, but has not been subject to scrutiny. The advice given in this Lancet article differs from that currently given by most manufacturers of suppositories, which involves the terms of their product licence. Hence, there is a potential for problems with legal liability should an untoward event arise. Relevance to clinical practice. Inserting rectal suppositories, whether as a medication or to achieve bowel evacuation, is a very common healthcare practice. Currently, there is inconsistency and discrepancy in the correct method for this procedure in both nursing education and practice. This paper examines the reliability of existing evidence and shows the need for further work in order to provide a reliable evidence base for this commonplace clinical procedure. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The paper discusses the application of the Eastern body-mind-spirit approach in healthcare practice. BACKGROUND: Traumas, sufferings and losses may induce immense distress in patients and their families, as well as apathy and exhaustion in healthcare workers. Over-specialization and compartmentalization of services may provide a convenient shelter for healthcare workers to be detached and to simply focus on a narrowly defined scope of intervention. However, the existential problems are still there. Based upon eastern philosophies and holistic health practices, we propose the body-mind-spirit approach in healthcare settings. METHODS: This is a review paper summarizing the application of the approach on various clinical populations. RESULTS: The approach has been trialled with promising results in a number of health conditions and psychosocial predicaments. Spirituality is not restricted to any religious practices, nor is it narrowed to the pursuit of knowledge at a high level of abstraction. The interconnectedness of the body, mind and spirit presupposes that the practice of spirituality is multidimensional and multi-levelled. CONCLUSIONS: Using the body-mind-spirit framework flexibly we can engage more clients while facilitating the important process of exploration and change. The key components include getting in touch with the inner self, coming back to our senses, connecting our body and mind and rebalancing our relationship with the natural and social environment. The ultimate goal is to move out of meaninglessness and to reach a state of mature spirituality of tranquillity and transcendence. RELEVANCE TO CLINICAL PRACTICE: The practice of spirituality can be easily applied to daily life. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: To explore the nature and extent of the legal duty of care in relation to contemporary healthcare practice. BACKGROUND: The paper seeks to re-frame and update the legal duty of care for clinical nursing practice in the 21st century, taking into account collaborative and partnership working in healthcare practice. DESIGN: Doctrinal legal 'approach'. METHOD: 'Black letter' legal research methodology used for data collection and analysis. Literature search using Westlaw and LexisNexis database(s) to identify recent common law decisions. RESULTS: There has been a perceptible doctrinal shift away from paternalism and toward patient empowerment and autonomy in the last decade. This has implications for nurses and other healthcare professionals in terms of consenting patients and acting reasonably to ensure quality patient care. CONCLUSIONS: A number of experienced nurses are currently assuming extended roles and some are completing medical tasks, traditionally allocated to doctors. These specialist practitioners must remember that additional responsibility invariably means increased professional risk and accountability. Therefore, it is essential that those engaging in advanced nursing practice, fully understand the nature and reach of their professional duty of care and the significance of statutory and common law developments. RELEVANCE TO CLINICAL PRACTICE: Nurses and other healthcare professionals must update their clinical skills and practice within a legal framework and to certain standards. The cases cited and discussed are relevant to all branches of nursing and indeed to all health professions. [ABSTRACT FROM AUTHOR]

Aim. To explore how protocol-based care affects clinical decision-making. Background. In the context of evidence-based practice, protocol-based care is a mechanism for facilitating the standardisation of care and streamlining decision-making through rationalising the information with which to make judgements and ultimately decisions. However, whether protocol-based care does, in the reality of practice, standardise decision-making is unknown. This paper reports on a study that explored the impact of protocol-based care on nurses' decision-making. Design. Theoretically informed by realistic evaluation and the promoting action on research implementation in health services framework, a case study design using ethnographic methods was used. Two sites were purposively sampled; a diabetic and endocrine unit and a cardiac medical unit. Methods. Within each site, data collection included observation, postobservation semi-structured interviews with staff and patients, field notes, feedback sessions and document review. Data were inductively and thematically analysed. Results. Decisions made by nurses in both sites were varied according to many different and interacting factors. While several standardised care approaches were available for use, in reality, a variety of information sources informed decision-making. The primary approach to knowledge exchange and acquisition was person-to-person; decision-making was a social activity. Rarely were standardised care approaches obviously referred to; nurses described following a mental flowchart, not necessarily linked to a particular guideline or protocol. When standardised care approaches were used, it was reported that they were used flexibly and particularised. Conclusions. While the logic of protocol-based care is algorithmic, in the reality of clinical practice, other sources of information supported nurses' decision-making process. This has significant implications for the political goal of standardisation. Relevance to clinical practice. The successful implementation and judicious use of tools such as protocols and guidelines will likely be dependant on approaches that facilitate the development of nurses' decision-making processes in parallel to paying attention to the influence of context. [ABSTRACT FROM AUTHOR]

Aims and objectives. As the basis for the design of career development opportunities for current and aspiring nursing and therapy consultants, we aimed to explore the factors that shape how these roles have embedded in UK stroke services. Background. The non-medical consultant role has been introduced into UK health care services to provide opportunities for experienced practitioners to progress their careers in clinical practice. Whilst there have been evaluations of the impact of the role on service delivery, little attention has been paid to the pathways towards consultantship. Design. An exploratory design, incorporating focus group discussions, was used to address the research questions. Participating consultants, both nurses and allied health professionals, worked in stroke services, although it is anticipated that the results will have wider application. Methods. Two focus groups were held with non-medical consultants in stroke from across the UK. Participants had the opportunity to comment on an interim paper prior to publication of the results. Thirteen consultants took part in the study. Results. A lack of consensus about the nature of clinical expertise and a diverse range of pathways towards consultantship were identified. Health care policy had presented the opportunity for consultants to be entrepreneurial in the development of stroke services, although this had limited the scope for the development of professional knowledge. Inflexible programmes to support aspiring consultants may limit the opportunities to develop these entrepreneurial skills. Conclusions. This study challenges health care organizations and the education and research departments that support them to think creatively in the way that the non-medical consultant role is embedded, and that this should draw on the commitment of existing consultants to support succession planning. Relevance to clinical practice. The identification of those aspects of career pathways that current consultants have found to be helpful will be useful in designing opportunities for aspiring consultants. [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper was to explore the concept of expertise in nursing from the perspective of how it relates to current driving forces in health care in which it discusses the potential barriers to acceptance of nursing expertise in a climate in which quantification of value and cost containment run high on agendas. BACKGROUND: Expert nursing practice can be argued to be central to high quality, holistic, individualized patient care. However, changes in government policy which have led to the inception of comprehensive guidelines or protocols of care are in danger of relegating the 'expert nurse' to being an icon of the past. Indeed, it could be argued that expert nurses are an expensive commodity within the nursing workforce. Consequently, with this change to the use of clinical guidelines, it calls into question how expert nursing practice will develop within this framework of care. METHOD: The article critically reviews the evidence related to the role of the Expert Nurse in an attempt to identify the key concepts and ideas, and how the inception of care protocols has implications for their role. CONCLUSION: Nursing expertise which focuses on the provision of individualized, holistic care and is based largely on intuitive decision making cannot, should not be reduced to being articulated in positivist terms. However, the dominant power and decision-making focus in health care means that nurses must be confident in articulating the value of a concept which may be outside the scope of knowledge of those with whom they are debating. RELEVANCE TO CLINICAL PRACTICE: The principles of abduction or fuzzy logic may be useful in assisting nurses to explain in terms which others can comprehend, the value of nursing expertise. [ABSTRACT FROM AUTHOR]

BACKGROUND: The concept of reflection is propounded in the literature as an epistemology for practice that enables practitioners to solve their daily problematic situations through conscious thought processes which eventually leads to practice-based knowledge. Hence, reflection became a central tenet of both theory development and educational provision in nursing. Furthermore, this centrality of reflection was reinforced by statutory nursing bodies and service providers by adopting it as the means for carrying out adequate professional practice. Although this may be the case, issues of implementation of reflection within the daily reality of practitioners are frequently overlooked within the literature. Moreover, little consideration appears to be given on the impact that the organizational culture and the politics of power may exert on the implementation of reflective practices within daily ward reality. AIMS: This paper explores how reflection is viewed by nurses within their daily reality in the medical wards, examines the relationships between the organizational culture of these wards and the practitioners and investigates whether reflective methods of practice were being implemented when the study was conducted. METHODS: An interpretative ethnographical methodology was implemented and the data collecting methods used were observation, interviews and qualitative content analysis with a group of 16 practising nurses from four medical wards of one NHS Trust in England. Two interviews were conducted with each nurse within 3-week intervals. The content of these interviews evolved from the analysis of episodes of practice observed when the nurses were giving nursing care. These data were supplemented by narratives from the nurses' in the form of written reflective accounts that were analysed via qualitative content analysis techniques. FINDINGS: Four themes were generated: (i) relationships between nurses and doctors; (ii) relationships between nurses and managers; (iii) nursing practice; and (iv) nurses' input in the outcome of a clinical situation. CONCLUSIONS: The concept of reflection appears to be invalidated by the organizational hierarchy of the wards on the basis of a power struggle game. The ward structure portrays reflection as an abnormal method of practice and knowledge development. This belittlement of reflection does not mirror the practitioners' reality. Instead, it is an intelligent and intentional act on behalf of the dominant professional groups in the wards to create an illusionary picture of ward reality to allow them to survey and define nursing practice and thus maintain and remain in power. This is explicated by using Foucault's analysis and critical social theory framework. Hence, reflective processes are constrained by this covert power game; reflection, where used, is confined to nurses' personal time and space. RELEVANCE TO CLINICAL PRACTICE: The realization of this covert power game by individual clinical nurses can become the incipient point for formally using reflective methods in the practice setting. [ABSTRACT FROM AUTHOR]

* The significance of primary health care to the health of individuals and communities has been well established but the development of primary health care and nursing practice within the context of primary health care remains varied in different countries and settings.* This paper focuses on developments in nursing practice in primary health care in Hong Kong, using three community-based research projects to identify the opportunities and challenges created for nurses working in these settings. The projects were established in response to identified health needs and to target cancer education, HIV/AIDS and chronic health problems.* Opportunities include the development of professional autonomy, innovative approaches to clinical practice, and developing skills in working with a diverse range of professionals and communities. Challenges include managing uncertainty and the development of evaluation systems to demonstrate health gains from nursing interventions. [ABSTRACT FROM AUTHOR]

The article presents a commentary on the paper "An analysis of clinical teacher behaviour in a nursing practicum in Taiwan," by L. L. Hsu. According to the author, the overall findings from the research raised a degree of concern in terms of patient safety and well-being. He stresses that the findings appear to be that in the clinical context, learning and teaching are driven by pragmatism.

The aims of the study were to investigate the advanced nursing practice and the skill-mix of nurses working in ophthalmology. Background. The expansion of new nursing roles in the United Kingdom in the past decade is set against the background of a nursing shortage. The plan to modernize the National Health Service and improve the efficiency and delivery of healthcare services as well as to reduce junior doctors' hours contributes towards a profusion of new and more specialized and advanced nursing roles in various areas of nursing including ophthalmology. Design. A self-reporting quantitative questionnaire was employed. The study used comparative and descriptive statistical tests. Method. The questionnaires were distributed to all ophthalmic hospitals and units in the United Kingdom. Hospital and unit managers were responsible for completing the questionnaires. Results. Out of a total 181 questionnaires 117 were returned. There is a downward trend in the total number of nurses working in ophthalmology. The results demonstrate more nurses working at an advanced level. However, there is a general confusion regarding role interpretation at the advanced level of practice, evident through the wide range of job titles being used. There was inconsistency in the qualifications expected of these nurses. Conclusion. Whilst there are more nurses working at an advanced level this is set against an ageing workforce and an overall decline in the number of nurses in ophthalmology. There is inconsistency in job titles, grades, roles and qualifications for nurses who work at an advanced or higher level of practice. The Agenda for Change with its new structure for grading jobs in the United Kingdom may offer protection and consistency in job titles, pay and qualifications for National Health Service nurse specialists. The Nursing and Midwifery Council needs to provide clear guidelines to the practitioners on educational and professional requirements, to protect patients and nurses. Relevance to clinical practice. The findings indicate that there is a need for better regulations for nurses working at advanced nursing practice. [ABSTRACT FROM AUTHOR]

When entering a ward the environment observed can be perceived in one of two ways: either from the perspective of 'background', this being the backdrop against which events take place, or as the main focus of attention, thereby alerting the observer to what is going on in the setting. Whilst undertaking their work nurses emit signs which patients, relatives and other staff interpret and through which they gain an understanding of the type of work about to be undertaken at the clinical interface. The themes of private work, showdown work and tragic plight work, which were generated from an observational study in a surgical ward, are discussed in this article. Findings show that, despite nurses attempts to hide the gravity of a message from patients, they in fact give more away than they hide. [ABSTRACT FROM AUTHOR]

The article discusses the implications on the current state of spirituality in the nursing practice. A growing interest of spirituality, particularly in the nursing practice in the Western culture, has been noted and nursing was found to be the venue for transforming that interest in spirituality into the practice of caring. Thus, concern in spirituality arose in response to the nursing care that is much centered on psychological and physical dimensions of patient's illness experiences.

Commentary on the article "Protocol-based Care: The Standardisation of Decision-making?" by J. Rycroft-Malone, M. Fontenla, K. Seers, and D. Bick is presented. Protocol-based care and clinical decision-making are discussed. Hospital protocols and their utilization by nurses are examined. The need for the nursing profession to examine the correlation between clinical decision-making and the implementation of evidence-based practice is also discussed.

Background. Daily sedation interruption (DSI) has been proposed as a method of improving sedation management of critically ill patients by reducing the adverse effects of continuous sedation infusions. Aim. To critique the research regarding daily sedation interruption, to inform education, research and practice in this area of intensive care practice. Design. Literature review. Method. Medline, CINAHL and Web of Science were searched for relevant key terms. Eight research-based studies, published in the English language between 1995-December 2006 and three conference abstracts were retrieved. Results. Of the eight articles and three conference abstracts reviewed, five originated from one intensive care unit (ICU) in the USA. The research indicates that DSI reduces ventilation time, length of stay in ICU, complications of critical illness, incidence of post-traumatic stress disorder and is reportedly used by 15-62% of ICU clinicians in Australia, Europe, USA and Canada. Conclusions. DSI improves patients' physiological and psychological outcomes when compared with routine sedation management. However, research relating to these findings has methodological limitations, such as the use of homogenous samples, single-centre trials and retrospective design, thus limiting their generalisability. Relevance to clinical practice. DSI may provide clinicians with a simple, cost-effective method of reducing some adverse effects of sedation on ICU patients. However, the evidence supporting DSI is limited and cannot be generalised to heterogeneous ICU populations internationally. More robust research is required to assess the potential impact of DSI on the physical and mental health of ICU survivors. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore the concept of busyness in nursing and to understand the relationship between busyness and nurses' research utilization better. Background. Lack of time and busyness are consistently reported as barriers to research utilization. Current literature fails to identify the dimensions of busyness and offers little insight into the relationship between busyness and nurses' research utilization. Design/Methods. We performed a secondary analysis of qualitative data and created a conceptual map of busyness in nursing. Results. Our results suggested that busyness consists of physical and psychological dimensions. Interpersonal and environmental factors influenced both dimensions. Cultural and intrapersonal factors contributed to psychological elements. The effects of busyness reported included missed opportunities, compromised safety, emotional and physical strain, sacrifice of personal time, incomplete nursing care and the inability to find or use resources. Conclusions. Our beginning description of busyness contributes to a greater understanding of the relationship between busyness and research utilization. Our findings suggest that lack of time as a barrier to research utilization is more complex than depicted in the literature. Instead, the mental time and energy required to navigate complex environments and a culture of busyness more accurately reflect what may be meant by 'lack of time' as a barrier to research utilization. Relevance to clinical practice. Future interventions aimed at increasing research utilization may be more effective if they focus on factors that contribute to a culture of busyness in nursing and address the mental time and energy required for nurses to use research in practice. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this study is to describe nurses' evaluations of factors that are hindering implementation of child-focused family nursing (CF-FN) into adult psychiatric practice. In addition, it explains the nurses' evaluations of the hindering factors related to the hospital organizational structure, the individual nurse, nursing and family. Background. There is an increasing amount of families with dependent children in adult psychiatry. Although these families have long-term benefits from preventive family interventions, implementation of CF-FN is not routine mental health practice. Design and methods. Data were collected via a questionnaire-survey completed by Registered Psychiatric Nurses (n = 223) and practical Mental Health Nurses (n = 88) from 45 adult psychiatric units in five Finnish university hospitals. The response rate was 51%. Results. Family-related factors, such as families' fears and lack of time, were considered as 'most hindering' to CF-FN. Nurses who used a family-centred approach and had further family education considered most of the factors as 'less hindering' in comparison to other nurses. Conclusion. To meet the needs of the families in mental health services, it is essential to develop nursing intervention methods such as CF-FN. There is a need for further education and use of family-centred care to develop this preventive approach. Relevance to clinical practice. The results of this study could be considered when developing mental health services and family interventions for families with parental mental illness. [ABSTRACT FROM AUTHOR]

Aim. This Norwegian-based study investigates how and to what extent the idea of the nursing home as a home has been realized. Background. For the last two decades, Norway, as other Western Country has had an explicit national policy that nursing homes should become more like homes. The research literature indicates that residents in nursing home seem to lack the opportunities to maintain a private sphere. Design. A field study design was conducted. Methods. Data were collected in 1999 in two long-term units in a traditional nursing home by using participant observation and interviewing the residents. A phenomenological hermeneutic analysis strategy was used to get an impression of the residents’ everyday life. Results. The residents spend most of their time in the common living room. The common living room has an ambiguous boundary between the public and private spheres, unlike the clear boundaries characterizing a home. The relationship among the residents is fragile, and the residents who can, withdraw from the common living room. Conclusions. Despite having single rooms and more home-like interior decoration, the residents in nursing home still have reduced opportunity to develop a private everyday lifestyle. The long-term unit examined in this research had a forced relationship between the residents, and the residents with best health resources systematically withdraw from the common area to control both where and with whom they wish to spend their time. Relevance to clinical practice. This study lays the foundation for rethinking daily routines in long-term units in nursing homes. One way to realize the idea of the nursing home as a home could be to define the living room as a clear public area and to give the residents a chance to develop a more private lifestyle by alternating between their private rooms and a public common living room. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to generate a deeper understanding of the factors and forces that may inhibit or advance the concepts of spirituality and spiritual care within both nursing and health care. Background. This manuscript presents a model that emerged from a qualitative study using grounded theory. Implementation and use of this model may assist all health care practitioners and organizations to advance the concepts of spirituality and spiritual care within their own sphere of practice. The model has been termed the principal components model because participants identified six components as being crucial to the advancement of spiritual health care. Design. Grounded theory was used meaning that there was concurrent data collection and analysis. Theoretical sampling was used to develop the emerging theory. These processes, along with data analysis, open, axial and theoretical coding led to the identification of a core category and the construction of the principal components model. Methods. Fifty-three participants (24 men and 29 women) were recruited and all consented to be interviewed. The sample included nurses ( n = 24), chaplains ( n = 7), a social worker ( n = 1), an occupational therapist ( n = 1), physiotherapists ( n = 2), patients ( n = 14) and the public ( n = 4). The investigation was conducted in three phases to substantiate the emerging theory and the development of the model. Results. The principal components model contained six components: individuality, inclusivity, integrated, inter/intra-disciplinary, innate and institution. Conclusion. A great deal has been written on the concepts of spirituality and spiritual care. However, rhetoric alone will not remove some of the intrinsic and extrinsic barriers that are inhibiting the advancement of the spiritual dimension in terms of theory and practice. Relevance to clinical practice. An awareness of and adherence to the principal components model may assist nurses and health care professionals to engage with and overcome some of the structural, organizational, political and social variables that are impacting upon spiritual care. [ABSTRACT FROM AUTHOR]

Aims and objectives. To identify factors which may influence attitudes to spiritual care, test the relevance of these identified influencing factors in a Swedish nursing context, and replicate a part of a previous study by Strang et al. ( Journal of Clinical Nursing 2002; 11:48-57) dealing with attitudes to spiritual care in a holistic perspective. A questionnaire was handed out to all nursing staff at a Swedish oncology clinic ( n = 93) excluding the radiation therapy ward. Data were obtained from 68 nurses or nursing auxiliaries. Design and methods. (i) Literature review of international research reports concerning spiritual care in a nursing context. (ii) Construction of a questionnaire comprising 17 questions with given alternatives based on the previous literature study. (iii) Operationalization of the concept 'attitudes to spiritual care' into some more easily measurable questions through identification in earlier research reports of conceivable indicators of attitudes to spiritual care. (iv) Construction of a suggestion for a definition of the concept 'spiritual care' from the results of Strang et al. (2002) to be used in the questionnaire. (v) Statistical analysis of the data from the questionnaire and a comparison with previous studies. Results and conclusions. The replicating part of the study are mainly in accordance with Strang et al. (2002) and lead to the conclusions that holistic care (i) is desirable, (ii) should include spiritual needs of the patients and (iii) is not yet realized in Swedish health care. The identified influencing factors are relevant in a Swedish nursing context. The factors influencing the largest number of indicators of attitudes to spiritual care are 'non-organized religiousness' and 'degree of comfort while providing spiritual care'. Other influencing factors are: 'belief in God', 'belief in life after death', 'organized religiousness', 'profession', and 'the perceived degree of education in spiritual care'. Relevance to clinical practice. Knowledge of attitudes towards spiritual care among nursing staff and factors influencing these attitudes will improve the possibilities of meeting the spiritual needs of patients. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: To explore implementation of the first five Best Practice Statements from the perspective of nurses involved in their development. BACKGROUND: Best Practice Statements were introduced in Scotland to encourage consistent evidence-based nursing practice. As a new initiative, research was required to investigate their clinical implementation. DESIGN AND METHODS: In this descriptive study, semi-structured interviews of a purposive sample of nurses (n = 15) were undertaken. Content analysis was used to identify themes emerging from the interview data. FINDINGS: Four main themes emerged from analysis of transcripts: variations in use of the Best Practice Statements; benefits to patients; benefits to practitioners; and, barriers and drivers to use. Amongst participants, personal users adopted the statements in their own practice but enablers also actively encouraged others to use the statements. Whether participants acted as enablers depended on individual, team and organizational factors. The ability of participants to act as leaders was influential in determining their ability both to facilitate local implementation and to encourage others to regard the Best Practice Statements as a priority for implementation. CONCLUSIONS: This exploratory study highlighted examples of patients and practitioners benefiting from the Best Practice Statements. Such findings suggest these statements could become a useful tool in promoting evidence-based nursing practice. However, implementation of the Best Practice Statements varied between participants and their organizations. Nurses who were most effective in promoting local implementation of the Best Practice Statements adopted facilitator and leadership roles within their organizations. RELEVANCE TO PRACTICE: By relating research findings to the literature on guideline and research utilization, this study gives further insight into the implementation of evidence-based practice by nurses. In particular, it supports the conclusion that to be truly effective, initiatives to promote evidence-based practice require nurses to act as local facilitators and leaders. [ABSTRACT FROM AUTHOR]

Focuses on the impact of agenda for health care in the nursing community in Great Britain. Description of practice agenda; Conceptualization of health care for nursing; Negotiations in the practice agenda.

Editorial. Focuses on the concept of clinical governance in health services in Great Britain. Definition of an iatrogenic condition; Discussion on complaints on nursing practices; Reasons for lack of progress in health service delivery.

Comments on the article "Universal precautions: a survey of community nurses' experience and practice," by G. Bennett and I. Mansell, which was published in a 2004 issue of the "Journal of Clinical Nursing." Problems experienced by health care staff with hand hygiene; Part of training and education of practitioners developing an awareness and improved adherence to clinical practice guidelines.

Editorial. Comments on the issue concerning clinical nursing practice associated with biomedical sciences. Problems on health care delivery; Role of nursing care on illness; Biomedical basis for the treatment and care of patients.

Discusses nursing development in continuous care of the elderly. Fundamental assumptions when developing nursing care and setting standards of care for the elderly; Issues in nursing values, work organization, communication and management support; Importance of organizational support in the development of standards of care.